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Monitoring: the end?

This may be the last time that I can. And despite my love-hate relationship with “monitoring” and my concerns about its utility, losing this is one of my primary reasons for voting #yesyes to strike action.

If you’re not familiar with it, “monitoring” is a way of checking that the hours worked by junior doctors match up with those that they’re rostered to work. It’s supposed to provide a check on excessive hours by imposing financial penalties on Trusts who repeatedly breach these contracted hours (e.g. if there are too few staff for the workload, or if people have left without adequate cover being provided). If you draw an analogy with driving offences, monitoring is the equivalent of a speed camera.

It’s a patient safety mechanism.

But it’s more than that: it’s a realisation that there is a gulf between the work outlined in our contracts and job descriptions, and the work that actually happens on the floor. It’s a recognition that we work in a service where demand is variable and that healthcare professionals will meet those demands. It is an acknowledgement that we don’t work “to rule”, and that our professional code is such that we don’t just “clock off” on time.

It’s useful for other reasons: it asks you to record if you’ve had a natural break – for years, I thought this was a polite way of asking if you’d had a chance to pee during shift. Recently, the form has been updated to explain that this is the 30 minute break we’re supposed to get. (The answer is usually no to both questions). It’s a useful check for me sometimes to realise that I don’t actually work every day of the week, and that maybe I need some days off. There is an option for “day off”, but there isn’t an option that says “Yes, I know it’s my day off but when else am I supposed to write my clinic letters?”

It is by no means perfect. The Trust have to collect the data, but the responsibility lies with the individual to defend the hours that they have worked. Experiences such as being called in to see the Clinical Director to explain why you stayed late are not uncommon; Trainee Encounter forms (usually used to pick up trainees who are struggling) have been used to report individuals for having poor time management if they complete their monitoring accurately. It can be “explained” to trainees that a post which consistently breaches the hours agreed will result in those posts being withdrawn, leaving their colleagues without a job…

I never thought I’d be sad to see it go. But the thought that this may be my last monitoring exercise makes me deeply, deeply worried for the future.